Tuesday, November 30, 2010

It's a Textbook! It's an Ad! It's Nemeroff/Schatzberg!

Drs. Nemeroff and Schatzberg are back in the limelight, once again dragging the good name of psychiatry through the mud. According to today's New York Times, in 1999 SmithKline Beecham, the maker of Paxil, funded and ghost-wrote a textbook for which this ethically-challenged duo took credit.

What were they thinking?

I imagine the conversation went something like this.

N: "Let's write a textbook for primary care doctors."S: "Sounds good. But I don't have the the time."N: "Neither do I."S: "Hmmm."N: "Hmmm."S: "So what do we do?" [N grins.] "Wait, you're not seriously considering--"N: "Why not? What are you, suddenly Dr. Holier Than Thou?"S: "All right, don't remind me about Corcept and your 60,000 shares. What's your plan?"N: "Simple. We know that SmithKline Beecham's Paxil is losing market share to Pfizer's Zoloft. I'll call my friends there, ask them for an 'unrestricted educational grant.'" [S nudges N. N grins and winks. But then S frowns.]S: "The money will be nice, but who's going to write it?"N: "SmithKline will hire a PR firm to do it. All we have to do is review it and make some final tweaks."S: "But isn't that a little sleazy, even for us? You know they'll play down Paxil's disadvantages--that it causes more sexual side effects, more weight gain, and more drug interactions than Zoloft."N: "Some studies show that's true, others are more equivocal."S: [Lightly socks N on the shoulder] "Don't BS me, you sound like you're giving one of your Paxil drug talks to naive country docs."N: "You know me too well!"S: "As usual you're very persuasive. I'm in."N: "I think this is the continuation of a beautiful friendship...."

Don't worry, I'm eagerly awaiting my full printed copy which will arrive from an Amazon re-seller soon. But Google books actually allows a pretty detailed look at content. You can use search terms such as "drug interactions" and "side effects" and "sexual dysfunction" and "weight" and it will show you all the excerpts that contain the terms, even when the entire context is not available.

I'll be amazed if the book has anything negative to say about Paxil. But if I'm wrong, I'll post it.

I paid 31¢ for my copy when I ordered it today. A bargain at half the price.

I like your docudrama, but I question its accuracy. I bet GSK called up and said, "Hey, you guys up for a textbook for primary care doctors. We need to tweak that market. It's where the action is. Don't worry about having to actually write the book. We've got that part covered."

For those of you that have never worked inside pharma, please understand that I worked with Dr. N and Dr. S often enough to know that if pharma had the idea these guys were savvy enough to milk it for all it was worth, often using insinuated extortion threats to get what they wanted. Pharma executives were scared that the "mafia" would bad mouth their meds, so they often capitulated. Why do you think it took a Seantor to bring Dr. N down? Dr. Carlat is right on...keep it up!

I think Dr. C. should consider a career on cable - Saturday Night Drugged? This stuff is so grim and disturbing that a good chuckle is deeply appreciated and much needed. On bleak days, I still check in on ACRE, Academics Craving Reimbursement for Everything.

Don't you find it strange that as soon as our field was overtaken by narcissists with questionable ethics, the APA DSM-IV Task Force proposed to do away with narcissistic and antisocial personality disorders?

I have the first edition of their joint authorship -- "Recognition and Treatment of Psychiatry Disorders" 2005 and it's very much in the DSM style. I am sure that they have collaborators in doing the research for it. But what do you guys expect for a Reference book on psychiatry -- original, creative poetry?

I must agree with mmmiusemaid. As pathetic as this is I am not sure it would have turned out much different if they had written it with their own hands/brains. You cannot pry apart the current psychiatric paradigm from the DSM, which is to a great deal based on the horribly tainted influence and research produced by the pycho-pharmicoindustrial complex which has come into existence over the last 50 years. I was taught this bullshit by people with a lot more integrity than both Curly and Moe who were willing to sign off on this steaming dung heap.

If psychiatry was actually to put out a textbook filled with information worthy of being considered actual "scientific knowledge" it would be about as long as a textbook entitled "America's Most Popular Lawyers".

Nemeroff's response published in the Miami Herald has as interesting comment. He essentially admits that the book was written to be distributed by Pharmaceutical Companies as a promo freebie. "In view of the reference to sponsor comments in the letter, I would guess that they would have had to review the content to comply with [Food and Drug Administration] regulations on a pharmaceutical company distributing a publication, but this is hardly my area of expertise." Recall from the NY Times, "The book sold about 26,000 copies, including 10,000 bought by SmithKline Beecham for American family doctors and 10,000 purchased by the Dutch pharmaceutical company Organon." And his public rebuttal doesn't address the ghost-writing allegation. He insists that they submitted an "outline" and "scrutinized" the drafts - skipping over the fact that they didn't happen to write those drafts themselves.

GSK [SKB then] and Oragon didn't get their payback by pushing their products directly. They got it by giving away the book itself - sort of like those Eli Lilly Reflex Hammers and Tuning Forks we all got when we started medical school...

@ SteveM: actually what I heard is that Charlie Nemeroff's threatening legal nastygram had the identical wording as Alan Schatzberg's threatening legal nastygram, which I guess just confirms that they really are clones - cheap, too.